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ObjectiveCommunication technologies, such as personal online health communities, are increasingly considered as a tool to realise patient empowerment. However, little is known about the actual use of online health communities. Here, we investigated if and how patients' use of online communities supports patient empowerment.SettingA network of primary and secondary care providers around individual patients with Parkinson's disease.ParticipantsWe conducted case studies to examine our research question. We interviewed 18 patients with Parkinson's disease and observed the use of online health communities of 14 of them for an average of 1 year.Primary outcome measuresWe analysed the interviews and the online conversations between patients and healthcare providers, using Foucault's framework for studying power processes.ResultsWe observed that patient empowerment is inhibited by implicit norms that exist within these communities around the number and content of postings. First, patients refrained from asking too many questions of their healthcare providers, but felt obliged to offer them regular updates. Second, patients scrutinised the content of their postings, being afraid to come across as complainers. Third, patients were cautious in making knowledge claims about their disease.ConclusionsChanging implicit norms within online communities and the societal context they exist in seems necessary to achieve greater patient empowerment. Possibilities for changing these norms might lie in open dialogue between patient and healthcare providers about expectations, revising the curriculum of medical education and redesigning personal online health communities to support two-way knowledge exchange.

In this article we adopt Barad’s theory of agential realism to explore how power and performativity are simultaneously processual and ontologically entangled. We use the hyphenated term power-performativity to mobilize an exploration of how power is not an ‘outcome’ or ‘effect’ of, but an inseparable flow within, the processes of performativity through which the world is continuously becoming. This moves us beyond the traditional, anthropocentric take on the relationship between power and performativity which emphasizes human agency and linear cause-effect, toward an alternative understanding of organizational phenomena as always enacted through myriad intra-acting more-than-human actants. To empirically mobilize this approach, we explore power-performativity within online healthcare, enacted through Personal Online Healthcare Communities (POHCs). We explore multiple ‘diffraction gratings’ through which particular outcomes of online healthcare come to matter, while others are prevented from mattering. In doing so, we posit the suitability of Barad’s agential realism for further explorations of the dynamics of power and performativity in modes of organizing and organizational life and offer tools for how these may be done.

This study examines how professionals engage with the increased surveillance of their daily work. We develop an understanding of professional surveillance at the micro-level of interaction by drawing on dramaturgical literature. Based on qualitative interviews and observational data of healthcare professionals using a new technology to communicate simultaneously with each other and individual patients, we analyse how professionals use different elements of the theatre (e.g., stages and scripts) to enact surveillance. The significance of our contribution lies especially in the dramaturgical reconceptualization of surveillance as enacted, making it an integral part of displaying one's professionalism.

Consumerist healthcare technologies and their creation of new inequalities This article examines how consumerist technology creates new inequalities among patients in healthcare. More specifically, we analyze a communication technology that presents a case of consumerization of patients. Using critical diversity literature, we aim to theorize how consumerism embedded in technology assumes a 'universal individual', creating a tension for healthcare professionals between acknowledging differences among patients while aiming for equal treatment of all patients. Based on our empirical analysis of so-called Personal Online Health Communities, we explore, at the microlevel, how healthcare professionals deal with this tension. We identify four different practices; lacking awareness of differences, downplaying differences, discomfort around acknowledging differences and actively accommodating differences. We theorize how they ultimately all create new inequalities.